Neonatal indicators and obstetric complications associated with degree of prematurity: A retrospective cohort study...

Preterm birth is a leading cause of neonatal morbidity and mortality, with earlier gestational age strongly associated with adverse neonatal outcomes.

Cyprus has one of the highest rates of preterm birth in Europe, yet country-specific evidence remains limited. Understanding how neonatal indicators and obstetric complications differ across degrees of prematurity is clinically and policy relevant, as it can inform antenatal counselling, optimize resource allocation, and strengthen maternal care pathways.

This study aimed to compare neonatal indicators and obstetric complications between extreme to very preterm births (<32 weeks of gestation) and moderate to late preterm births (32 to <37 weeks of gestation) in Cyprus.

A retrospective cohort study was conducted using data from singleton preterm births at a tertiary hospital in Cyprus. Categorical variables were compared using chi-squared or Fisher's exact tests and continuous variables using the Mann-Whitney U test. Univariable and multivariable logistic regression analyses were performed to assess associations with extreme prematurity adjusting for maternal age, BMI, smoking, parity, education and country of origin.

The study included 489 singleton preterm cases. Infants born extremely to very preterm had significantly lower birth weights and APGAR scores, and a higher frequently of intrauterine growth restriction, indicating greater neonatal compromise. Lower APGAR scores (per unit) at one and five minutes were strongly associated with extreme prematurity (aOR=0.653; 95% CI: 0.587-0.727; p < 0.001 and aOR=0.44; 95% CI: 0.31-0.62; p < 0.001, respectively). Birth weight (per gram) was also associated with decreased odds of extreme prematurity (aOR=0.955; 95% CI: 0.993-0.996; p < 0.001). Obstetric complications independently associated with extreme prematurity included placental abruption (aOR=3.75; 95% CI: 1.65-8.49; p = 0.002), vaginal bleeding (aOR=2.71; 95% CI: 1.27-5.76; p = 0.010), and preeclampsia (aOR=2.03; 95% CI: 1.02-4.02; p = 0.042). Placenta previa showed an inverse association with extreme prematurity (aOR=0.42; 95% CI: 0.18-0.96; p = 0.039).

These findings highlight the clinical consequences of placental and hypertensive complications during pregnancy, with distinct neonatal profiles associated with earlier gestational age. The inverse association with placenta previa warrants cautious interpretation and further investigation. For midwifery practice, these results underscore the importance for early identification and close monitoring of women at risk, as well as timely counselling and referral to optimize outcomes.

Targeted antenatal surveillance and timely management of obstetric complications may reduce the risk of extreme prematurity. Recognition of neonatal correlates such as low birth weight and reduced APGAR scores can support early clinical assessment and care planning. Midwives, through continuity of care, timely recognition and referral of complications, and provision of psychosocial support, are central to implementing these strategies and improving outcomes for mothers and infants at risk.